Demand exists for multicultural care

After Congress passed the Refugee Act of 1980, which created the Federal Refugee Resettlement Program, three million refugees came to this country. Additionally, 43.3 million immigrants were settled in the U.S. in 2015, according to American Community Survey data.

This influx of individuals from other countries is creating awareness within the psychological community for a broader understanding of diverse needs and how to deliver appropriate and effective mental health care.

Martin R. Pierre, Ph.D., member of the Massachusetts Psychological Association board of directors, co-chair of its Committee on Ethnic Minority Affairs, and staff psychologist at the Brandeis University Counseling Center, said, “I think of multicultural and cultural psychotherapy as an integrative framework that allows therapists and researchers to formulate concepts around clients.
Individualistic, relational and contextual variables provide clinicians with specific treatment recommendations.”

Individualistic variables involve constitutional factors around the client’s worldview and values related to self esteem, according to Pierre.

“This is what the client brings to the process,” he noted. “The relational aspect of therapy is what the therapist brings to the encounter. It’s equally as important as what the client brings and helps to develop a therapeutic alliance with the individual client.”

Pierre added that the contextual variable is “…related to the social context in which the client is embedded.”

This variable might include socio-political and geo-political factors, history and geography. “This is the most empowering component and could evolve the therapy to help the client bring about changes in social condition and understanding of political context to move forward,” he said.

While therapy typically embraces universality, treating clients from different cultures requires different approaches, based on the presenting issues. “It’s important to collaborate with the client and give him a sense of being understood in a culturally sensitive manner,” Pierre said.

In his group practice, Pierre treats a number of undocumented immigrants whose problems are similar to his U.S. clients. “But how they conceptualize [those problems] and the meaning they attach to them are clinically different syndromes,” he said.

As part of the therapeutic process, Pierre validates and acknowledges the client’s feelings and recommends connections to help increase self-agency. “They often want to isolate themselves,” he said. “I recommend connecting with the broader community: extended family – related or not – church, social service agencies and other resources within the community.”

However, working across these various agencies poses a challenge, according to Pierre. “I embrace an ecological/systemic approach, not treatment devoid of context, meaning I work with the school system, family members, attorneys, different mental health providers, such as case workers and psychiatrists and employers,” he said.

Jill Betz Bloom, Ph.D., associate professor, Clinical Psychology Department; co-director, Center for Multicultural and Global Mental Health; and director, Global Mental Health Concentration at William James College, reported that the school created the Dr. Cynthia Lucero Center for Latino Mental Health in 2002 and, more recently, the African-Caribbean Mental Health and Global Mental Health programs to promote global justice for all citizens.

As part of the curriculum all students are required to participate in an immersion service program, Bloom said, explaining that this experience helps students better understand global mental health needs.

The immersion programs include visits to Haiti, Kenya, Ecuador and Guyana and reflect collaboration. “The goal is not to come in and dictate. We work with local stakeholders and ask what they want. We use the term ‘community capacity building,’” she said. “When [the stakeholders] identify needs, we help empower them to create sustainability. It’s not us telling them what to do, rather it’s a ‘knowledge exchange.’ We learn from the populations we serve.”

For instance, Haitian youth tend to leave the country when they get older, which negatively affects the community. “We teach them that they have a role in the investment in the community,” Bloom said. “We also work with educators. Schools are closed from June to October and the children are idle. They need something to do. We are developing a workshop with the educators on expressive art.”

Bloom noted that the student group will work with local non-governmental agencies in Guyana this year. “[Guyana] has the highest suicide rate in the world. It’s a low-income country with no mental health infrastructure,” she said. “We will do training and psychoeducation for medical staff in Georgetown, the capital.”

Bloom emphasized that fostering understanding of other cultures and partnering with those communities to provide social and emotional support is the “direction the field needs to go.”

The Center for Multicultural Mental Health (CMMH) at Boston Medical Center has been training students for 45 years, according to Associate Director Shamaila Khan, Ph.D. The program explores a “way of being for us” that reflects the identity and history of the student body; 85 percent of interns in the program have racially and ethnically diverse backgrounds.

Mentorship is a big part of the CMMH program, according to Khan. Unlike supervision, which is more clinical in nature, mentorship is more personal. “The mentor is open to sharing history and to guide students, learn why [students] are here and how to incorporate ‘ways of being,’” she said.

CMMH offers between 50 and 60 seminars throughout the year on various subjects. “The topics shift, depending on what’s happening in the world. We have open-ended discussions, many of which are of a political nature,” Khan said. “The topic of immigration is implicitly part of the program.”

Khan, who has traveled to disaster sites in Pakistan, Haiti and Japan, explained that when such a crisis occurs an integrated team comprising a physician, social worker, psychologist and nurse, administer “psychological first aid” upon arrival.

She said, “It really helps [the citizens] to understand this is first aid. Just the way you have a physical scar, this is an emotional scar.”

There are no easy answers to treating a multicultural client base, according to Pierre. However, he said that training to offer effective therapy is important. “It’s ethically responsible to do so,” he said. “If we don’t embrace a multicultural lens we would over-diagnose or misdiagnose the culturally different client and would not be addressing their psychological needs.”